WO2009141460A1

WO2009141460A1 - Portable device for upper limb rehabilitation

Info

Publication number: WO2009141460A1
Application number: PCT/ES2008/000365
Authority: WO
Inventors: Ettore Cavallaro; Thierry Keller
Original assignee: Fundacion Fatronik
Priority date: 2008-05-23
Filing date: 2008-05-23
Publication date: 2009-11-26
Also published as: AU2008356483A1; EP2298266B1; US8795207B2; CN102088945A; CA2725270A1; JP2011520579A; AU2008356483B2; CN102088945B; EP2298266A1; BRPI0822752B8; BRPI0822752A2; JP5140760B2; KR101504793B1; KR20110034596A; BRPI0822752B1; ES2431056T3; CA2725270C; US20110295165A1

Abstract

The invention relates to a portable rehabilitation device (10) intended for a user with a disability that makes it difficult to perform simultaneous extension and lifting movements. The device includes a supporting element (12) for the arm, to which the user's forearm can be secured, and means (16) for moving the arm-supporting element on a surface. The device also includes means (18) for monitoring the movement of the arm-supporting element and means (13) for detecting a force exerted by the user's arm in a direction orthogonal to the surface. The device enables the user to perform extension movements over a wide area, with his/her forearm supported and secured. Since the forearm is supported and secured, the device enables improved control of shoulder training movements, preventing uncontrolled elbow movements that can occur upon gripping a handle.

Description

PORTABLE DEVICE FOR MEMBER REHABILITATION

HIGHER

BACKGROUND OF THE INVENTION

Technical field

The present invention relates to a portable device for rehabilitating a user affected by a disability with difficulties in executing simultaneous extension and lifting functions. The device is particularly suitable for use in physiotherapy and / or rehabilitation programs for the treatment of neurovascular or musculoskeletal lesions or diseases of the upper limb.

Description of the related technique Hundreds of thousands of people are disabled every year due to motor alterations of the upper limb. The alteration may be due to neurological diseases such as stroke (see, for example, statistics updated to 2007 of heart attacks and diseases of the American Heart association and the American stroke association), or it may be due to musculoskeletal injuries. In both cases the disease can result in a decreased range of motion, muscle weakness, loss of speed and / or reduced coordination of the affected limb.

Physiotherapy is known to be effective in reducing the degree of disability (Nancy ByI et al., Neurorehabilitation and Neural Repair, vol. 17, n ° 3, 176-191 (2003); Darlene Hertling, published by Lippincott Williams and Wilkins, 2005). The recently published research work (Liesbet De Wit et al., Stroke. 2007; 38; 2101) confirms that better results are obtained in rehabilitation in those health centers in which patients receive more treatment per day for prolonged periods of time . Currently, physiotherapy is only administered in hospitals or specialized health centers. A physiotherapist causes the patient to perform a series of repeated exercises during training sessions that generally have a limited number and duration due to the availability of therapists and the cost. In addition, it is generally difficult to assess the degree of alteration at the beginning of the treatment and quantify the benefits of the treatments due to the lack of objective measurement techniques.

Robotized devices have the possibility of improving this situation. An intelligent robot mechanically coupled with the patient's arm can be used to help the patient carry out the exercises during the rehabilitation period, thus increasing the time invested in rehabilitation training. In addition, the robot sensors can be used to assess the degree of the alteration at the beginning of the therapeutic cycle and monitor the progress. In fact, a series of robotic devices have been developed in recent years for both academic and commercial purposes. For example, at the University of Washington, Seattle, USA. an upper limb exoskeleton powered with 7 degrees of freedom has been developed as a rehabilitation / assistance device to treat dysfunctions that involve a loss of strength in the upper limb. Researchers at the Scuola Superiore Sant'Anna, Pisa, Italy developed the MEMOS system, a Cartesian robot with two degrees of freedom at low cost for the motor recovery of the upper limb after a stroke. The ACT 3D system has been developed at North-Western University, USA, to create a virtual world for arm movement training during the grip and release functions.

Research in academic settings has also generated a small number of commercial devices. For example, MIT-Manus developed within the framework of academic research at MIT, Boston, USA. and subsequently patented (U.S. Patent No. 5,466,213

(1995)) is now marketed by Interactive Motion Technology, USA, such as InMotion 1, 2,3 devices for use in the rehabilitation of the shoulder, elbow and wrist.

Similarly there are a number of patents filed in the field. For example, Erlandson (US Patent No. 4,936,299 (1990)) describes an apparatus and procedure for rehabilitation that takes advantage of a robotic arm controlled by a CPU.

Baker (patent n ⁰ CA 2244358 (2000)) discloses a therapeutic device for rotation of the wrist rehabilitation Ia Ia wrist. Reinkensmeyer et al. (US Patent No. 6,613,000 (2003)) describes a computer-based system that provides a treatment for arm movement for patients with sensory disturbances that can function through the web and provides personalized therapeutic exercise programs. Diaz et al. (US Patent No. 2005/0273022 A1 (2005)) describe a portable medical device for joint rehabilitation by means of a continuous passive movement. Dewald et al. (US Patent No. 2007/0066918 A1 (2007)) describe a system for the rehabilitation of dysfunction in the coordination of the limbs induced by the force of gravity after a stroke or other neurological disorders. The results of clinical and study trials carried out with robots such as MIT-Manus indicate that robot treatment is safe, well accepted by patients and useful (see for example Krebs et al., Technol. Health Care 7, 6 (December 1999), 419-423.).

However, the present generation of rehabilitation robots still has some unresolved issues that prevent its use on a large scale.

Among these the cost is an important one. The robotic device should be economical enough for health centers to adopt it to a large extent. Simplicity of use is also a matter in case patients have to use the robotic device at home. The "domestic use" feature also requires the portability of the device. In fact, the devices and / or patents described above can be broadly classified into two categories: (1) expensive and non-portable devices that can be used to implement a series of different rehabilitation programs given their complex structure; (2) simpler, more specialized devices that can be used for a limited number of rehabilitation programs.

Various patents for such specialized devices have been published. For example, US Patent No. 2007/0021692 describes a system for performing induced movements of the members. The trajectories of the hand or foot are recorded by position sensors and the pressure exerted by the member can be recorded.

WO 99/61110 describes a system for training rapid extension movements (anticipation movements). The system incorporates measurement of the position (hand, arm, joints), measurement with EMG and user feedback.

US Patent No. 7,311,643 describes a portable exercise board for the shoulder and upper limb. It provides means to move a handle in a plane with a discretely variable coefficient of friction. Japanese Patent No. 2007185325 describes a system for performing extension exercises on a table. The system is portable and provides measurement of the position and force exerted by the user on a handle. The position of the handle does not provide information about the configuration of the arm. Japanese Patent No. 2002272795 describes a rehabilitation device for the upper limb that includes a measurement of the position and the force exerted by the user on a handle (transport device) and feedback means. The system requires an instrument table with guides on which the transport device can move.

Japanese Patent No. 2004008605 describes an apparatus for member rehabilitation training. It provides means to measure the force exerted by a member on a fixed device together with means to provide feedback to the user, such as video, sound, vibration). It is an objective of the invention to provide a simple and economical device that allows the user to make extension movements in a wide work area.

SUMMARY OF THE INVENTION For this, according to an aspect of the invention, a portable device according to independent claim 1 is provided. Favorable embodiments are defined in dependent claims 2 to 26.

The portable device for rehabilitating a user affected by a disability with difficulties to perform simultaneous extension and lifting functions according to the present invention comprises an arm support to which the user's forearm can be attached and means to allow the movement of the support for The arm on a surface. It also includes means for monitoring the movement of the arm support, that is, the position / speed / acceleration and orientation thereof. Finally, it comprises means for detecting a force exerted by the user's arm on the arm support in a direction orthogonal to the surface.

Simplification and cost reduction are introduced into the device according to the present invention. The proposed device is in fact a mobile robot instead of being a fixed device, a device based on a frame or a device that moves on a rail or guide. This provides portability. It also addresses the needs of special rehabilitation techniques through modularity.

The device according to the present invention, unlike the previously described devices of the prior art, allows the user to perform extension movements in a wide area of work having the supported forearm and subject. The fact that the forearm is supported and attached to the device allows a better control of the training movements of the shoulder, avoiding uncontrolled trajectories at the level of the elbow that are possible in case of only grasping a handle. At the same time detecting the rotation and position of the device, due to the fact that the forearm is fixed to the device, guarantees a better quantitative assessment of the three-dimensional position of the arm.

The device is designed for elbow and shoulder training, although it can also be used to train the wrist and grip by adding specific modules. The number, duration, intensity and type of training session can be controlled by software running in the central processing unit of the device. The network capabilities of the device according to a preferred embodiment of the invention allow its use in telerehabilitation environments, in which the user and the physiotherapist are not in the same place, although the physiotherapist can monitor and change the parameters of the rehabilitation program in any time that is required.

In the field of rehabilitation, one of the problems that is solved by the device according to the present invention is related to the assessment and treatment of dysfunctions of the upper limb due to anomalous synergies between shoulder abduction and elbow flexion activated by the weight of the member himself. Patients with chronic stroke are an example of individuals with an alteration who have generations of abnormal motor torque patterns. When a subject with an alteration tries to make an extension away from the body and has to completely compensate for the gravity that acts on the limb, its extension movement is involuntarily linked to an elbow flexion. This prevents the subject from performing the extension movement in a natural way. However, it has been shown that motor learning capacity is still present in patients with chronic stroke, which could allow recovering a more functional pattern of shoulder and elbow activation. (EIIiS et al., Muscle Nerve. August 2005; 32 (2): 170-8).

By means of the present invention, a subject can perform extension movements having the arm supported and measuring the degree of lifting force that can be exerted, preferably by means of a force sensor. In a preferred embodiment, the subject is also provided with feedback about the position and orientation of the forearm, and the lifting force exerted. He / she can then engage in extension and elevation movements to perform some functions represented in a virtual scenario that can be used to train your functional recovery of the correct synergies of the elbow / shoulder. For example, the position and the lifting force can be used to control two degrees of freedom in a game-like scenario shown on an LCD screen. Therefore, the invention can be used to provide a quantitative assessment of the condition of the subject at the start of rehabilitation training and to provide training in an effective manner.

In addition, this result is achieved by avoiding the use of articulated robots or suspended orthoses of cables.

The invention provides a training and measurement device and procedures for training and / or self-training and assisting individuals who have neurological or musculoskeletal disorders that result in the partial loss of the ability to move the upper extremities. The device is preferably modular allowing to reach a different degree of functionality / complexity of the system. In one of its embodiments, the device is a mobile robot of light weight and small size that is operated on a table (or any other suitable surface). The robot is equipped with a base platform that has conventional wheels or spherical wheels. An arm support is mounted on the base platform in which the user can hold his forearm. The arm support is connected to the robot base so that its height with respect to the base can be selected in a range of default values. It is also equipped with torque / force sensors so that at least the forces exerted by the user along the vertical axis can be measured. The mobile base is equipped with sensors, such as optical tracking sensors, which allow the robot's position / speed / acceleration monitoring and therefore also its arm support. The device comprises fastening means for fastening the forearm to the arm support, in which the fastening means are selected from the group of: sailboat ribbons, pneumatic bracelets, and 3D printed bracelets adapted to the shape of the forearm of a single Username. A feedback interface is provided, usually a video screen (although it could be used for video, audio, touch or a combination thereof) so that the user can monitor his own activity. The device is part of a system equipped with a processing unit, a storage unit and a cable / wireless communication unit.

The robot is designed so that it can be operated by patients. An auxiliary system can be provided that communicates remotely with the robot through a network protocol. This auxiliary system is designed for use by the optional staff and provides data storage and processing means along with the appropriate software to analyze and interpret the data collected and sent by the robot during the rehabilitation sessions.

In order to establish the initial degree of alteration and monitor the improvement of the patient with the treatment, a measurement procedure can be implemented. The procedure is based on the measurement and recording of the movement of the mobile base of the robot and of the motor / force pairs applied by the user in the arm support.

The rehabilitation training procedure takes advantage of software that interactively instructs the patient about the function that the mobile robot must continue to use. The patient continuously receives feedback about their performance in a kind of interactive game.

The type of exercise to be performed can be decided remotely by the health center staff and / or constantly adapted to the user's performance. The complete system can be modular, so that the embodiment described above can be integrated by extension modules to extend its functionality.

In one embodiment, actuators can be added to the mobile base in order to introduce an assisted displacement (the user starts the movement and the system helps the user to complete it) or active (the system moves the user's arm, in a safe way, through predetermined paths) of the mobile robot on the surface of the table, so that force fields can be simulated.

In another embodiment, the mobile unit has no wheels, but a base that can be dragged on a pad. The friction between the pad and the base of the mobile robot can be varied by selecting the materials from which they are made. For example, Teflon over Teflon has a static friction coefficient of 0.04.

In another embodiment, the pronosupination training of the wrist or the radiocubital inclination can be included by means of a support device for the arm developed in an appropriate manner. The training of the grip can be added in the same way.

In another embodiment, the functional electrical stimulation (EEF) can be added to the capacity of the system in order to improve the treatment. In another embodiment, EMG monitoring of the muscles of the upper limb may be added in order to provide the faculty with more data about muscle activations in order to adjust the treatment appropriately.

In another embodiment, EEG monitoring can be introduced to provide the faculty with information about brain activation patterns during rehabilitation. In another embodiment, a linear actuator can be added to the interface between the arm support and the mobile device along the vertical axis.

In another embodiment, a joint position measurement system can be integrated into the device to directly monitor the shoulder, elbow and wrist joints of the patient.

In another embodiment, a 3D position measurement system (such as for example the Patriot or Fastrak Polhemus and the like) can be integrated into the device to directly monitor the shoulder, elbow and wrist joints of the patient. In another embodiment, the spherical wheels are provided with electrically controlled brakes, so that the effort required to move the mobile robot can be controlled.

In another embodiment, there is a set of CMOS or CCD cameras that can be used to monitor training movements in a qualitative and / or quantitative manner (trajectories and / or angular positions of the member).

In another embodiment, the mobile device is used on a pad. The pad may contain areas with different heights. The vertical position of the device is deduced by the position of the device in the plane together with a 3D software map of the pad.

These and other aspects of the invention will become apparent from and will be clarified with reference to the embodiments described below in this document.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be better understood and its numerous objectives and advantages will become more apparent to those skilled in the art by referring to the following drawings together with the attached specification, in which: Figure 1 shows a schematic top view of the portable device according to an embodiment of the present invention. Figure 2 shows a schematic longitudinal side view of the device shown in Figure 1.

Figure 3 shows a schematic bottom view of the device shown in Figure 1. Figure 4 shows a schematic cross-sectional side view of the device shown in Figure 1.

Figure 5 shows a simplified three-dimensional view of the device shown in Figure 1.

Figure 6 shows a block diagram of a rehabilitation system according to an embodiment of the present invention.

Figure 7 shows a schematic view of a possible use case of the device shown in Figure 1.

Figure 8 shows a block diagram of the concept of simultaneous rehabilitation. Figure 9 shows the calculation of the position and orientation of the portable device.

In all figures, similar reference numbers refer to similar elements.

DETAILED DESCRIPTION OF THE PRESENT INVENTION

Now, with reference to Figures 1 to 5, an exemplary embodiment of the portable device 10 according to the invention will be described. The portable device, which is also referred to in this description as a mobile unit or mobile robot, is composed of a base 14 of the device, which is also referred to in this description as a mobile platform with three spherical wheels 16, arranged in the vertices of an equilateral triangle, which allow the movement of the portable device. As passive spherical wheels, Alwayse or Omnitrack or similar commercial ball transfer devices can be used. A support 12 for the arm, to which the user's forearm can be attached, is connected to the mobile platform. An optical tracking device is inserted in the mobile platform 14 so that the position and orientation of the device can be calculated while moving.

The optical tracking device is composed of two optical mouse sensors 18. One of the two sensors is located in the center of the mobile platform; the other is located at a distance L from the center and in the direction of the longitudinal axis of the arm support. The reading of the two sensors provides a relative position measurement. The system is calibrated at the beginning of use by placing it in a predefined orientation and position. Now, with reference to Figure 9, if P ≡ (Xp, Yp) is the position of the central optical sensor and Q ≡ (Xq ₁ Yq) is the position of the other sensor with respect to the orthogonal reference system centered on the initial position from P (Po), the X axis from P to Q and the Y axis and oriented so that the Z axis is directed upwards from the surface of the table, then the position of the device at each moment is (Xp ₁ Yp) and The orientation of the device

(angle of the longitudinal axis of the arm support with respect to its initial position) can be calculated with simple trigonometric formulas. For example, for (Xq-Xp) X) and (Yp-Yq) ≥O, β = atan ((Yp-Yq) / (Xq-Xp)). The extension of this formula or other equivalent formulas to cover the entire orientation space is evident to those skilled in the art.

The portable device represented in Figures 1 to 5 can be used advantageously in a system represented in Figure 6, which is composed of three main units: the portable device 10 used to passively or actively support a member against the force of gravity while allowing an unlimited plane movement, a calculation and feedback unit 30 and a remote viewing and control unit 60. In addition, a pad (with a textured polymer surface or a polyester surface or the like) can be used to provide a surface suitable for the movement of the portable device 10. The pad may include some obstacles or paths or three-dimensional structures specifically designed in which you can Move the mobile device.

The mobile platform 14 features an inserted processing unit 26 (such as a Gumstix ™ module or the like) that has an analog input expansion, a digital input / output expansion and a wired / wireless communication expansion. The analog input expansion accepts signals from the torque / force sensors 13 that measure the force exerted on the arm support 12, from the optical sensors (18) or both.

In an embodiment of the device, the arm support 12 is provided with a force sensor of 3 degrees of freedom that monitors the forces on the vertical axis and on the two axes that identify the plane parallel to the horizontal surface. The force sensor can be implemented using extensometers or similar techniques as is done in commercial products (ATI torque / force sensors or the like). The arm support can also be provided with a damping device that allows limited displacement and can be selected from the arm support on the vertical axis when a force is applied on that axis. The arm support is also provided with sailboat belts or other similar means 20 for attaching the patient's arm to the mobile device.

The portable device may comprise actuators 22 to provide an assisted movement or active movement of the mobile base and actuators 24 to control the height of the arm support with respect to the base of the device and / or flexibility against vertical forces. The calculation and feedback unit 30 comprises a processing unit 32, a transceiver unit 34 for transmitting data to and receiving data from the inserted processing unit 26, a storage unit 36 and a feedback interface 40 to provide feedback to a user 50. The calculation and feedback unit 30 provides the visual and / or acoustic and / or tactile feedback that allows the patient to act in a virtual scenario by the affected arm supported by the portable device 10. In one embodiment, the calculation and feedback unit is composed of a screen (LCD or other commercial screen) and speakers, which communicate with a commercial PC. The PC can acquire data transmitted through a wireless link from the sensors located in the portable device 10 or from a sensor located in the environment or on the user's body, or both. Wireless transmission can be performed using the 802.11 or similar protocol (for example, WUSB, etc.). A game-like software runs on the PC and the user plays in order to perform the rehabilitation functions. The software also collects raw data and collects and calculates user performance statistics using routines written ex profeso. In addition, the software has the ability to send data to a server present in the medical center through a conventional Internet connection. The software can also receive new sets of parameters to adjust the rehabilitation functions according to the decisions of the medical staff in the medical center.

The remote viewing and control unit 60 is composed of a conventional PC that has means for transmitting and receiving information 62 to and from the calculation and feedback unit 30, such as an Internet connection. This PC uses the optional staff 80 to monitor and control the rehabilitation procedures carried out by the patients at home. The software that runs on this PC collects information from all clients through an encrypted connection to preserve patient privacy. The information is stored in permanent memories such as, but not limited to, hard drives. A UPS system and a data backup system can also be provided. The software can be used for real-time monitoring (block 64) of a patient. The software can display information through several IGU 70s and can calculate and display data statistics and other useful information for the faculty to monitor the rehabilitation training procedure (block 66). The faculty can also use the software to adjust the parameters of portable devices (block 68).

Now a series of exemplary cases of use of the system described above are included here as a means to clarify certain possible uses of the present invention. These use cases do not represent limitations of the invention.

In a typical scenario, the system can be used to administer a treatment to reduce the lack of coordination induced by the force of gravity in patients with unilateral brain lesions. In fact, it is known that specifically designed training functions can help patients with chronic stroke to significantly reduce generations of abnormal torque patterns and thus improve the area of extension and movement speed (Ellis et al ., Muscle Nerve. August 2005; 32 (2): 170-8).

According to this scenario, the patient is initially in the health center, where his condition can be assessed using the proposed system. Registered information is stored to serve as a reference. After the evaluation, the optional staff chooses a treatment program and consequently configures the system software. The patient can then be taught how to use the system properly. The medical staff also decides whether the patient should start treatment at the health center or should be sent to the home to continue treatment with the portable device. When at home (or even in the health center) the patient can perform the exercises without the need for constant assistance and their progress can be monitored remotely by the faculty who can adjust the training exercises according to improvements in the condition of the patient.

As Figure 7 shows, while using the device, the user 50 is sitting comfortably in front of the table 110 on which the portable device 10 is located. A pad 120 can be used specific depending on the implementation. He / she secures the forearm 140 of the affected arm to the arm support by belt straps or any other fastening system provided by the device. The system can then be turned on and performs self-tests and can ask the patient to perform a simple function to complete a calibration phase. After completing the self-test and calibration, the system will start the training session, starting from the initial position 130 of the portable device.

In a typical scenario, the calculation and feedback unit 30 comprises a video screen (LCD or other) and speakers that are connected to the processing unit 32 that receives data from the portable device 10. The video screen and the speaker present the user with an interactive game that must be played to perform the training function. The portable device 10 acts as the input device for the game.

In addition, the system could be connected to a server 100 specifically designed to allow group treatment. In this way, several users can carry out the training at the same time, receive information about the activity of others and compete or collaborate as part of the training.

The group treatment could take the form of an online CRPG (online computer role playing game) or MMORPG (massively multiplayer online role-playing game, massively multiplayer online role-playing game) online . Figure 8 represents a block diagram of a concept of simultaneous rehabilitation of this type. IU 1 ... n users affected by a disability use the part of the system described in Figure 6 and called 'health or domestic center'. UN 1 ... n users not affected by a disability use commercial input devices (control levers, keyboards, etc.). The medical staff in the health centers 90 uses the part of the system described in Figure 6 and called the 'health center'. In this way various training modalities are made available:

(1) The user can connect to a "virtual rehabilitation center" (perhaps within a virtual Internet-based world such as Second-Life or others) and follow the instruction of a therapist along with other users;

(2) The user can carry out the rehabilitation function as part of a team game with other users who are also training;

(3) The user can play a game together with people not affected by a disability who use conventional input devices to interact in the game. All these modalities have the possibility of introducing a "recreational" or "fun" dimension in the rehabilitation routine that can improve the acceptability and the result of the treatment itself. In a typical situation, training involves the execution of an extension movement combined with an elevation of the arm (shoulder abduction). The user has his forearm fixed to the portable device 10. The device can move freely on the surface of a table. The extension movement causes the device to move on the table by registering the position sensors 18 the relative orientation and position of the portable device 10 and thus of the support 12 for the arm and the forearm attached to it. In a typical case, the user will not be able to perform the shoulder abduction plus the extension correctly without help due, for example, to abnormal synergies developed after a stroke. However, the arm support Ie will allow to compensate for these synergies since it is not obliged to lift the weight of the arm.

In this simple case, the support 12 for the arm has a fixed position with respect to the mobile base that allows isometric training of the shoulder abduction. The force exerted by the forearm on the arm support is monitored by the force sensors 13 inserted in the connection between the arm support and the mobile base. Therefore, the user You can measure your progress in the ability to raise the arm while performing an extension movement because you can see a decrease in the force measured by the force sensor. In the ideal case, the user should be able to fully support the weight of his arm while performing the extension function.

In more complex cases, the vertical displacement of the arm support with respect to the base can be controlled by a damping system or can be assisted by some actuators, so that more complex rehabilitation patterns can be implemented. In any case, the measurement of force, orientation and position constitute inputs that can be used to interact with the training software as a game. The software can be very simple, as in 2D play. For example, the user moves in a simple maze using the position and orientation of the forearm while performing functions trying to raise the arm (overcome obstacles, reach bonus points that hang, etc.). In more complex scenarios, the device can be used to interact in a multi-user online game and / or an Internet-based virtual world, with other users affected by a disability or with healthy users. In this way, the social and recreational dimension added to rehabilitation training could accelerate it and / or make it more effective.

Although the invention has been illustrated and described in detail in the drawings and the above description, such illustration and description must be considered illustrative or exemplary and not restrictive; The invention is not limited to the described embodiments.

Those skilled in the art can understand and make other variations with respect to the embodiments disclosed by practicing the claimed invention, from a study of the drawings, the description and the appended claims. In the claims, the term "comprises / n" does not exclude other elements or stages, and the indefinite article "a" or "a" does not exclude a plurality. A single processor or another unit can fulfill the functions of various elements mentioned in the claims. The simple fact that certain measures are mentioned in dependent claims different from each other does not indicate that a combination of these measures cannot be used advantageously. A computer program may be stored / distributed on a suitable medium, such as an optical storage medium or a solid state medium supplied jointly or as part of other hardware, although they may also be distributed in other forms, such as over the Internet or other wireless or cable telecommunications systems. No reference number in the claims should be construed as limiting the scope.

Claims

1. Portable device (10) for rehabilitating a user affected by a disability with difficulties in performing simultaneous extension and lifting functions, comprising:

- a support (12) for the arm to which the user's forearm can be attached

- means (16) to allow movement of the arm support on a surface, - means (18) to monitor the movement of the arm support and

- means (13) for detecting a force exerted by the user's arm in a direction orthogonal to the surface.

2. Portable device according to claim 1, wherein the means for allowing movement of the arm support are spherical wheels or conventional wheels.

3. Portable device according to claim 1, wherein the means for allowing the movement of the arm support are constituted by a flat base that can be dragged on a pad (120).

4. Portable device according to any one of the preceding claims, further comprising at least one actuator (22) to provide an assisted movement or active movement.

5. Portable device according to any of claims 1 to 3, comprising at least one braking system for controlling movement.

6. Portable device according to any of the preceding claims, wherein the means for detecting a force exerted by the user's arm comprises at least one force sensor.

7. Portable device according to any of the preceding claims, wherein the means for monitoring the movement of the arm support are adapted to monitor the position, and / or speed, and / or acceleration, and / or orientation of the support for the arm, and comprise at least one position sensor.

8. Portable device according to any of the preceding claims, further comprising a base (14) that provides the means for the movement of the device on a surface, the arm support (12) being connected to the base of the device.

9. Portable device according to claim 8, comprising means for fixing the arm support at different heights with respect to the base of the device.

10. Portable device according to claim 8, wherein the arm support is provided with at least one actuator (24) for controlling the height of the arm support with respect to the base of the device.

11. Portable device according to claim 8, wherein the arm support can rotate freely or by controlled actuators to

Io along its main axis in order to facilitate pronation-supination movements of the forearm.

12. Portable device according to any of the preceding claims, further comprising fastening means for securing the forearm to the arm support, in which the fastening means are selected from the group of: sailboat belts, pneumatic bracelets, clamps or bracelets printed in 3D, deformable fixing clamps.

13. Portable device according to any of the preceding claims, further comprising means for measuring the articular position to directly monitor the wrist, elbow and shoulder joints of the patient.

14. System comprising a portable device (10) according to any of the preceding claims and a feedback and calculation unit (30), comprising a central processing unit (32), a storage unit (36), an interface ( 40) feedback and a unit (34) for cable or wireless communication.

15. System according to claim 14, wherein the feedback and calculation unit (30) is provided to implement a visual, or acoustic or tactile feedback or a combination thereof.

16. System according to claim 14 or 15, wherein the feedback and calculation unit (30) is adapted to provide the user with an interactive game to be played to perform the training function by means of the portable device to which it is attached your forearm

17. System according to any of claims 14 to 16, wherein the system is adapted for use in group treatment in which the user can compete or collaborate with other users in a training function.

18. System according to any of claims 14 to 16, wherein the system is adapted to connect to a server (100) for games to interact with an online game of multiple users and / or a virtual world based on the Internet.

19. System according to any of claims 14 to 18, further comprising means for providing functional electrical stimulation (EEF).

20. System according to any of claims 14 to 19, further comprising means for EMG monitoring of arm muscles.

21. System according to any of claims 14 to 20, further comprising means for monitoring with EEG of brain activation patterns during rehabilitation.

22. System according to any of claims 14 to 21, further comprising a set of CMOS or CCD cameras of low resolution for video monitoring the training movements of the arm qualitatively and / or quantitatively.

23. System according to any of claims 14 to 22, further comprising a pad containing areas with different heights.

24. System according to any of claims 14 to 23, further comprising a remote viewing and control unit (60) for use by the staff (80) capable of monitoring and controlling the rehabilitation procedures of patients comprising a processor , which has means (62) to transmit and receive information to and from the feedback unit (30) and calculation.

25. System according to claim 24, wherein the remote viewing and control unit (60) comprises means (68) for adjusting parameters of portable devices.

26. System according to claim 24 or 25, wherein the means (62) for transmitting and receiving information to and from the feedback and calculation unit (30) use an encrypted connection.